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General NPI Number Information
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NPI Number | 1477690428
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Entity Type | Organization
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Legal Business Name | GRANDVIEW FOOT AND ANKLE PC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 231 W PINE LAKE DR SUITE NUMBER 102
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City | NEWAYGO
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State | MI
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Zip | 49337-8028
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Country | US
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Telephone | 231-652-5955
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Fax | 231-652-5956
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Provider Business Mailing Address
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Address Line | PO BOX 362
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City | HASTINGS
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State | MI
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Zip | 49058-0362
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Country | US
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Telephone | 269-948-9155
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Fax | 269-948-9577
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Authorized Official
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Title or Position | PODIATRIST
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Name | STACY AARON UEBELE
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Credential | DPM
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Telephone | 269-948-9155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SU001970
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License Number State | MI
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